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Chapter 13. Somatoform Disorders

Sean H. Yutzy, M.D.; Brooke S. Parish, M.D.
DOI: 10.1176/appi.books.9781585623402.296590

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Excerpt

The somatoform disorders were first delineated as a class of psychiatric disorders in DSM-III (American Psychiatric Association 1980). The class was created to facilitate the differential diagnosis of disorders characterized primarily by "physical symptoms suggesting physical disorder (hence somatoform) for which there are no demonstrable organic findings or known physiological mechanisms and for which there is positive evidence, or a strong presumption, that the symptoms are linked to psychological factors or conflicts" (American Psychiatric Association 1980, p. 241). With minor modifications, this grouping and its underlying concept were retained in DSM-III-R (American Psychiatric Association 1987) and, after some debate (Martin 1995), in DSM-IV (American Psychiatric Association 1994) as well as DSM-IV-TR (American Psychiatric Association 2000). (Noteworthy here was that the explicit diagnostic criteria from DSM-IV remained the same in DSM-IV-TR.) In contrast to factitious disorders and malingering, somatoform disorder symptoms are not under voluntary control. The stipulation in DSM-IV-TR that symptoms are not fully accounted for by known physiological mechanisms distinguishes somatoform disorders from disorders formerly designated as psychophysiological disorders, some of which are included in DSM-IV-TR under "Psychological Factors Affecting Medical Condition." Beliefs involving preoccupations with symptoms are not of delusional intensity, except possibly for body dysmorphic disorder. Symptoms are not better accounted for by other mental disorders.

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FIGURE 13–1. Distribution and number of sick leave occasions in Swedish somatizing ("high-frequency") subjects and control nonsomatizing subjects.Source. Reprinted with permission from Cloninger CR: "Somatoform and Dissociative Disorders," in The Medical Basis of Psychiatry, 2nd Edition. Edited by Winokur G, Clayton PJ. Philadelphia, PA, WB Saunders, 1994, pp. 169–192. Copyright 1994, WB Saunders Company.
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TABLE 13–1. DSM-IV-TR somatoform disorders: a comparison
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TABLE 13–2. DSM-IV-TR somatoform disorders and corresponding categories in previous DSM and ICD diagnostic systems
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TABLE 13–3. Feighner criteria symptom list for hysteria (somatization disorder)
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TABLE 13–4. DSM-IV-TR diagnostic criteria for somatization disorder
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TABLE 13–5. Features useful in discriminating between somatization disorder and general medical conditions
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TABLE 13–6. General medical conditions that may be confused with somatization disorder
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TABLE 13–7. Main treatment principles in approaching a patient with somatization disorder
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TABLE 13–8. DSM-IV-TR diagnostic criteria for undifferentiated somatoform disorder
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TABLE 13–9. DSM-IV-TR diagnostic criteria for conversion disorder
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TABLE 13–10. Key terms
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TABLE 13–11. DSM-IV-TR diagnostic criteria for hypochondriasis
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TABLE 13–12. DSM-IV-TR diagnostic criteria for body dysmorphic disorder
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TABLE 13–13. DSM-IV-TR diagnostic criteria for somatoform disorder not otherwise specified
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The somatoform disorders are grouped because they suggest a physical disorder for which there are no organic findings or known physiological mechanism or there is a strong presumption that the symptoms are linked to psychological issues.

Somatization disorder is uncommon, but it is considered one of very few valid and reliable mental illnesses.

Conversion disorder is a diagnosis that should be applied only after significant effort has been expended to eliminate any possible treatable organic disorder.

Hypochondriasis is a rather uncommon disorder that usually follows a fluctuating course.

Body dysmorphic disorder is a diagnosis in evolution, with conflicting data regarding amenability to treatment.

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CME Activity

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Sample questions:
1.
Several features are useful in differentiating between somatization disorder and physical illness. Which of the following is more indicative of somatization disorder than of physical illness?
2.
Other psychiatric disorders must be carefully considered in the differential diagnosis of somatization disorder. The most troublesome distinction is between somatization disorder and which of the following psychiatric disorders?
3.
Which of the following statements concerning epidemiological findings in somatization disorder is true?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
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